1. Keith J. Mueller, Ph.D. Director, RUPRI Center for Rural Health Policy Analysis Professor and Head Department of Health Management and Policy University of Iowa College of Public Health Presentation to the UI College of Public Health’s Business Leadership Network Community Forum Charles City, Iowa November 6, 2014

2.  “Form follows finance”  Commercial insurance changing, and employer plans changing  Medicare changes are dramatic and could be more so  Medicaid changes spreading 2

3.  Change is underway (not just “coming”)  Driven largely by needs to refinance  But also involving reorganizing to meet quality objectives  Respond to change or lead change but CHANGE 3

4.  Value will determine payment, initially partial eventually all  Responding to those changes  Value will take on a new meaning beyond the hospital/clinic walls 4

5.  Value is value to the people served, the community  Value is creating and maintaining health  Requires collaborations across all activities and programs that influence health, including social determinants of health 5

6.  County Health Rankings & Roadmaps program  a collaboration between the Robert Wood Johnson Foundation Robert Wood Johnson Foundation  the University of Wisconsin Population Health Institute.University of Wisconsin Population Health Institute  Much of what influences our health happens outside of the provider’s office 6 http://www.countyhealthrankings.org/about-project/rankings-background

7. 7

8.  Knowing what is impacting adverse health outcomes in the community  The challenge of how a community compares to others  The challenge of how a community compares to a gold standard  Forms the basis for action strategies tied to measurable goals for achievement 8

9.  From Community Health Needs Assessment Snapshot, Floyd County Public Health/Home Health Care  Healthy Behaviors, Problems/Needs:  Obesity  Cancer  Diabetes  Parenting skills  Prevent Injuries Problems/Needs  Texting while driving  Mental health access  Underage drinking 9

10.  Protect Against Environment Hazards: Safe Drinking Water  Prevent Epidemics and Spread of Disease: immunization rate  Prepare for, Respond to, and Recover from Public Health Emergencies  Strengthen the Public Health Infrastructure: access to dental services 10

11.  From Mercy Medical Center – North Iowa CHNA Report of priorities among categories of need 1 Care coordination: between providers, between providers and patients 2 Community wellness: motivation for preventive activities, communication wellness opportunities 3 Substance abuse/mental health: propensity of chronic disease, “siloed” care between providers 4 Access to care: access to medical appointments, emergent dental care for adults 5 Parenting/self-responsibility: adequate self-value to prevent destructive behaviors, accountability for one’s own health 11

12. 6 Chronic disease management: motivate for self-management/compliance, continue to collaboratively address heart disease and diabetes 7 Transportation: to medial appointments, especially for those living out of town, communicate availability of resources 8 Homeless/temporary shelter: safe place on short term basis for men, women and accompanying children; coordinate with other housing resources 9 Safety: unintentional injuries; suicide 12

13.  Robert Wood Johnson Foundation County Health Rankings  Health Outcomes: premature death, self-report health status  Health Behaviors: tobacco use, diet and exercise, alcohol and drug use, sexual activity  Clinical care: access to care, quality of care  Social and Economic Environment: education, employment, income, family and social support, community safety  Physical Environment: air and water quality, housing and transit 13

14.  Health Outcomes: 59 of 99 (3 rd quartile)  Health Factors (combines four domains): 58 of 99 (3 rd quartile)  More detail available from the web site: www.countyhealthrankings.org www.countyhealthrankings.org 14

15.  Descriptions available from Rural Health Value (a U of IA project in partnership with Stratis Health): http://www.raconline.org/topics/statistics-and- data/data-sources-and-tools http://www.raconline.org/topics/statistics-and- data/data-sources-and-tools  Examples: American Community Survey, Economic Research Service Fact Sheets, American Fact Finder 15

16.  From the County Public Health Department  Goal: Decrease Percent of County Residents who are overweight /obese to 65% from baseline of 67%  Quarterly newsletter available to residents with information regarding healthy lifestyle choices  Team with hospital staff to promote healthy eating choices 16

17.  Nemours Children’s Health System in Delaware and beyond uses prevention and population health measures in their Balanced Scorecard and Executive Compensation Initiatives  MN initiative to effectively address social determinants of health, led by state health department: uses community health needs assessment, a Healthy Minnesota 2020 framework, creation of Accountable Communities for Health 17

18.  Western Mass: Communities that Care Coalition in a rural region: uses a community action plan based on data from annual teen health survey to generate goals for reduction in youth substance use – coalition of schools, human service providers, local law enforcement, local business, government, faith- based organizations, health care and mental health providers, hospital: 12 year reduction in abuse 18

19.  Western North Carolina Healthy Impact: partnership of hospitals, health departments, and key regional partners in multicounty (16) region to standardize data collection, create reporting and communication templates and tools, encourage collaboration, provide technical assistance, address regional priorities, and share evidence based practices 19

20.  The Rural Health Value project website for further examples of innovation in rural places: www.ruralhealthvalue.org  Other organizations focused on assistance to rural healthcare organizations and their communities (next slide) 20

21. 21 The National Rural Health Resource Center The Rural Assistance Center The National Rural Health Association The National Organization of State Offices of Rural Health The American Hospital Association

22. Rural Health Value http://ruralhealthvalue.org Center for Rural Health Policy Analysis http://cph.uiowa.edu/rupri The RUPRI Health Panel http://www.rupri.org 22

23. Department of Health Management and Policy College of Public Health, N232A 145 Riverside Drive Iowa City, IA 52242-2007 319-384-3832 keith-mueller@uiowa.edu keith-mueller@uiowa.edu 23